WHEN Aneurin Bevan set up the NHS in 1948, he couldn't persuade GPs to become employees of the state.

Now, nearly 60 years later, Plaid Cymru's Helen Mary Jones is arguing that salaried GPs represent a new way forward.

Yesterday Ms Jones announced the recommendations of Plaid's Wellbeing Policy Commission, which will feed into the party's manifesto for next year's Assembly election.

One of the most significant proposals involves setting up a network of "Wellbeing Centres" across Wales, involving salaried GPs, nurses, physiotherapists, counsellors and others, including dentists.

The report said, "During the consultation period the Wellbeing Commission became aware of growing concern regarding access to primary healthcare services in local communities across Wales.

In Powys concerns were raised regarding the lack of NHS dentists in the region, while in Rhondda Cynon Taf patients discussed having to wait three weeks for a GP appointment.

"From the founding of the NHS in 1948, primary care such as GPs' surgeries and primary dental care has been provided almost exclusively by independent contractors and at present are commissioned by Local Health Boards.

"While the services provided to the people of Wales has been of the highest standard, during our consultation period we became aware that there were some areas in Wales where the provision of health advice and services to the community cannot be left solely to depend on the fortunate presence of sufficient numbers of independent contractors.

"The Wellbeing Commission is not recommending a wholesale change in the current GP model; however for those areas in particular which cannot retain independent contractors we recommend the development of Wellbeing Centres where members of staff would be publicly salaried."

The commission also called for the way the health service operates to be reviewed by a National Commission on the Governance of Wales.

Ms Jones said the present system was not working with dozens of organisations responsible for laying on services in the Welsh NHS.

"The idea of having 22 local health boards with the same boundaries as county councils was a good one in principle when it was made," she said.

"What's obvious is the current situation isn't sustainable. It has not delivered in terms of getting them to work better together."

She said future public sector structures could be considered by a National Commission that would take evidence for between two-and-a-half and three years and make proposals that would be debated during the 2011 Assembly election campaign.

Providing free care for the elderly and the disabled should be a long-term goal for a Plaid Assembly Government, the report says. Labour dropped a manifesto commitment on the policy earlier this year when it proved too expensive.

Ms Jones said it would take time to finance and gradually introduce such a commitment.

"We are not going to make a promise we can't keep," she added.

Dr Andrew Dearden, chairman of the GP Committee for Wales of the British Medical Association, said, "The idea of having salaried GPs isn't entirely new - there are some employed by the local health board in Cynon Valley, for example. But introducing it on a more general basis would be extremely expensive and unaffordable. A study of the five or six managed practices in Wales during 2004 and 2005 showed that they cost about #1m more than traditional practices run by GPs themselves.

"What has to be remembered is that there are a lot of costs to be added when GPs are salaried - at present they pay for their own holidays, maternity leave, sickness etc. And whereas it is GPs themselves who currently fund new surgeries, centres employing salaried staff would have to be funded from within the NHS budget.

"It's also the case that GPs who have put down roots in a community by investing their own money are more likely to stay in the long-term than those on a salary.

"The key is to make conditions attractive, for example by helping out women GPs on maternity leave and writing off young GPs' student debts."

Rhondda Labour AM Leighton Andrews said, "Plaid doesn't seem to realise that Rhondda Cynon Taf Health Board is already making a success of salaried GPs. And it would not be appropriate to nationalise every GP surgery in Wales."